A registered nurse (RN) is working with unlicensed assistive personnel (UAP) on a medical-surgical unit. Which task can the RN safely delegate to the UAP according to the five rights of delegation?
1Assisting a stable post-operative patient with ambulation who has been cleared by physical therapy✓ 정답
2Administering oral medications to a patient with diabetes mellitus
3Performing initial assessment of a newly admitted patient with chest pain
4Teaching a patient about insulin injection techniques before discharge
해설
Delegation to UAP must follow the five rights: right task, right person, right circumstances, right direction/communication, and right supervision. Assisting a stable post-operative patient with ambulation is routine and predictable, making it safe to delegate. Other options involve assessment, medication administration, or teaching, which are outside UAP scope.
Core Nursing ExplanationKey Concept Analysis: This question tests the application of the Five Rights of Delegation in nursing practice. Delegation is the process of transferring the authority to perform a selected nursing task to a competent individual (like a UAP) while the RN retains accountability for the outcome. The five rights are: Right Task, Right Circumstances, Right Person, Right Direction/Communication, and Right Supervision. The core principle is that the RN can only delegate tasks that are within the UAP's scope of practice, are routine and predictable, and do not require nursing judgment or specialized knowledge.
Answer Rationale: Key Point! Assisting a stable, cleared post-operative patient with ambulation is the correct answer. This task is a routine, non-invasive activity of daily living (ADL). It is predictable (the patient is stable and cleared), requires no nursing assessment or judgment during its execution, and falls squarely within the typical training and scope of a UAP. The RN's responsibility is to provide clear instructions (e.g., distance, precautions) and supervise the process.
Distractor Analysis:
Watch out for confusion! Administering oral medications (Option 2) is never a task for UAPs. Medication administration is a core nursing function that requires assessment of the patient, knowledge of the drug, and evaluation of its effects. It is protected by the Nurse Practice Act.
Performing an initial assessment (Option 3) on a patient with a potentially unstable condition (chest pain) requires advanced clinical judgment to identify subtle signs of deterioration. Assessment is a fundamental, non-delegable responsibility of the RN.
Teaching a patient (Option 4) about a complex skill like insulin injection requires evaluating the patient's readiness to learn, assessing comprehension, and ensuring safe technique. Patient education is a skilled intervention that requires nursing knowledge and judgment and cannot be delegated to a UAP.
Related Concepts: Understanding delegation is critical for patient safety and effective team management. It is distinct from Assignment (giving tasks to other licensed personnel like LPNs/LVNs, whose scope is broader than UAPs). The RN's accountability is absolute; you cannot delegate a task you are not competent to perform yourself.
Concept Summary
Concept
Description
Key Takeaway
Five Rights of Delegation
Framework for safe task transfer: Task, Circumstances, Person, Direction, Supervision.
RN retains accountability. Used for UAPs.
Right Task
Task must be routine, predictable, and require no nursing judgment.
Examples: Ambulation, feeding, bathing, vital signs (on stable pts).
Non-Delegable Tasks
Nursing process (Assessment, Diagnosis, Planning, Evaluation), medication administration, patient education, sterile procedures, IV push/chemotherapy.
These require RN's specialized knowledge and judgment.
UAP (Unlicensed Assistive Personnel)
Assists with basic patient care under RN supervision (e.g., CNA, PCT).
Scope is limited to ADLs and simple, defined tasks.
Side-by-Side Comparison!
Delegable to UAP (Stable Patient)
NOT Delegable to UAP (Requires RN)
Assisting with ambulation (post-PT clearance)
Initial nursing assessment
Measuring and recording routine vital signs
Interpreting abnormal vital signs
Assisting with feeding (no swallowing issues)
Administering any medication (oral, topical, IV)
Making an occupied/unoccupied bed
Developing or revising a care plan
Transporting stable patients
Providing discharge teaching
Anatomy, Physiology & Pharmacology Points
While delegation itself isn't an A&P topic, the tasks you delegate relate to patient stability. For example, delegating ambulation requires understanding that the patient is hemodynamically stable (stable blood pressure, heart rate) and has no contraindications like dizziness or new pain, which the RN must assess first.
Memory Tips
Mnemonic: CAN DELEGATE? (Criteria for UAP tasks): Common/routine, Assistance with ADLs, No assessment/judgment needed, Defined procedure, Expected outcome, Low risk, Easy to supervise, Good communication possible, Appropriate training, Task is stable/predictable, Evaluation by RN after.
Think "MAP": If the task involves Medication, Assessment, or Patient teaching/Planning, it is for the RN.
High-Frequency NCLEX Topics
Delegation and supervision are Key Point!extremely high-yield on the NCLEX. The exam tests your ability to prioritize, assign tasks appropriately, and recognize what you can and cannot delegate, especially to UAPs. Always ask yourself: "Does this task require nursing judgment or is it a routine, stable-care activity?"
Watch Out for Question Variations!
The NCLEX can test this concept in many ways:
Priority: "Which task should the RN delegate first?" (Choose the most routine, stable task).
Supervision: "The UAP reports a patient's blood pressure is 190/110 mm Hg. What is the RN's priority action?" (Assess the patient yourself—interpreting abnormal data is non-delegable).
Assignment to LPN/LVN: Questions may involve delegating to Licensed Practical Nurses, whose scope is broader (e.g., may administer some medications but not IV push).
Nursing Clinical Practice GuideClinical Scenario: You are the RN in charge of a 10-patient medical-surgical unit. Your team includes two UAPs. One of your patients, Mr. Jones, is 2 days post-op knee replacement, is afebrile, has stable vital signs, and was cleared for ambulation by physical therapy this morning. Another patient, Mrs. Smith, was just admitted with worsening heart failure and needs a full assessment.
Nursing Intervention Strategy:
Assessment (RN): Assess Mr. Jones yourself first. Check his pain level (should be controlled), vital signs, and ensure there are no new orders restricting activity. Review the PT note.
Delegation (RN to UAP): Using the Five Rights:
Right Task: "Please assist Mr. Jones in room 204 with walking in the hallway for 10 minutes."
Right Circumstances: The patient is stable, cleared, and the environment is safe.
Right Person: You delegate to a UAP who is trained in safe ambulation techniques.
Right Direction/Communication: Be specific: "Use the gait belt. Have him walk to the nurses' station and back. Stop if he has pain, shortness of breath, or dizziness, and call me immediately."
Right Supervision: You are available if needed. You will evaluate Mr. Jones after the ambulation.
RN Focus: While the UAP assists with ambulation, you proceed to perform the initial, non-delegable assessment on Mrs. Smith.
Patient Safety and Precautions:
Never delegate a task you have not first assessed the patient for.
Clear communication is vital. Vague instructions like "help him walk" are unsafe.
If a UAP reports an abnormal finding (e.g., patient became dizzy), you must immediately stop the delegated task and assess the patient yourself.
Nursing Procedure & Medication Flow
While this case doesn't involve a specific procedure, the delegation process is a critical professional procedure:
Verify Patient Stability & Orders: RN completes initial assessment to ensure the patient is appropriate for the delegated task.
Select Competent Staff: RN ensures the UAP has the training for the task (e.g., use of gait belt).
Provide Clear, Concise Instructions: Include the task, parameters, and specific signs/symptoms to report.
Supervise & Be Available: RN remains responsible and accessible.
Evaluate & Follow-up: RN evaluates the patient after task completion and provides feedback to the UAP.
A Word from Your Senior Nurse
Delegation isn't about dumping work; it's about smart teamwork to provide safe, comprehensive care. Your license is on the line with every task you delegate. If you wouldn't feel comfortable leaving the unit while that task is being done, you probably shouldn't delegate it. In the real world, effective delegation allows you to focus your advanced skills on the patients who need them most. On the NCLEX, always protect your license and your patient by remembering the golden rule: Assessment, Medication, and Patient Education (the "A.M.P." rule) stay with the RN.